Treatise on the diseases of the eye : including the anatomy of the organ / by Carl Stellwag von Carion ; tr. from the 3rd German ed. and ed. by Charles E. Hackley and D.B. St. John Roosa ; with an appendix by the editors.
- Karl Stellwag von Carion
- Date:
- 1870
Licence: Public Domain Mark
Credit: Treatise on the diseases of the eye : including the anatomy of the organ / by Carl Stellwag von Carion ; tr. from the 3rd German ed. and ed. by Charles E. Hackley and D.B. St. John Roosa ; with an appendix by the editors. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
743/810 page 721
![as far from its cut end as may be necessary. The muscle should be drawn well out and kept upon the stretch, so that the sutures may be passed through it as deeply as possible behind the caruncle, to secure a firm hold, and to leave a somewhat longer mass between the perforations made by the sutures and the ligature upon its cut end than the original divergence measured. The course of the sutures should be perpendicular to the plane of the muscle, one pas-ing through near its upper margin, and the other near its lower. After the sutures have been placed in the muscle, the end included in the ligature should be cut off, care being taken to leave enough to prevent their tearing out. The amount cut should nearly equal the degree of divergence to be corrected, allowance being made for shrinkage which has followed the detachment of the muscle from the sclerotic. The next step is to carry the sutures beneath the conjunctiva above and below the cornea. It is better to place the upper suture first. This also requires the curved needle. The point aimed at in carrying the needle along the sclerotic, beneath the conjunctiva, should he about a line above the cornea and over the center of the line of implantation of the superior rectus muscle, and there the suture should emerge. Before tying the upper the lower suture should be brought out at a corresponding point over the inferior rectus insertion. While the operator is cautiously tying the sutures his assistant should, catching hold of the insertion of the external rectus, carry the cornea toward the internal canthus as much as possible, and thus effect what may be considered the real intention of the operation, namely, to adduct the eye strongly, and thus place the end of the shortened internal rectus in co-aptation with the sclerotic at the natural line of sclerotic implantation. The exercise of a little care will cause the muscle to spread out and be hidden behind the horizontal pillars of the wound through which the retentive sutures have been carried; and thus insuring a consolidation of the wounded parts, obtain the aid of the subsequent cicatritial contraction of the soft parts intervening between the cornea and the caruncle in the ultimate result. This method has been employed upon two eyes which had been rendered divergent by operations for convergent squint. In one of these eyes the divergence was more than five lines, in the other about four. In the first eye a small amount of con- vergent squint was induced, which was cured by applying the glass, which neutralized existing hypermetropia. In the second case a very slight degree of convergence was caused, not exceeding a line, which was also removed by the use of the proper glasses. And in both these cases the existence of hypermetropia would have ren- dered glasses necessary, aside from any convergence. The operation has also been satisfactorily performed in two cases in which slight paresis of the internal rectus, the result of injury, had led to divergent squint. No inflammation of an annoying character has followed the procedure. It is believed that the chance of success is greatly increased by dividing the external rectus of the fellow-eye, even though it is proposed to advance the internal rectus of one eye only. (Agnew.)] 11. In cases of secondary squint, where the mobility in the course of the retracted muscle is completely or almost completely removed, especially where the muscle has drawn itself completely back, and has no connection with the globe, and in all cases where the angle of squint is very large, even if the limitation of motion in the course of the muscle which has been laid back was only to a moderate degree, the stitching forward is no longer sufficient. Then a g'eater bringing forward of the end of the muscle is necessary, and this may be attained by the so-called thread operation. This method is also to be recommended in all cases of great paralysis 46](https://iiif.wellcomecollection.org/image/b2107902x_0743.jp2/full/800%2C/0/default.jpg)
